Murasato Y, Ninomiya K, Imai M, Araki M, Kawasaki I, Ibayashi H, Abe H, Kuroiwa A
Department of Internal Medicine, Moji Rousai Hospital, University of Occupational and Environmental Health, Japan.
Jpn Circ J. 1994 Aug;58(8):671-5. doi: 10.1253/jcj.58.671.
A 75-year-old male underwent cardiac catheterization for frequent ventricular premature contractions and reduced left ventricular function. ECG on admission showed complete right bundle branch block (RBBB) and left anterior hemiblock. Right heart catheterization was performed uneventfully, but complete atrioventricular block (CAVB) occurred suddenly when a pig-tail catheter was inserted into the left ventricle. Electrophysiological study identified this CAVB as HV block, and demonstrated HV prolongation in sinus rhythm. The coronary angiogram revealed no obstructive lesion or spasm with ergonovine. The reproducibility of the CAVB was demonstrated. The final CAVB developed and persisted for more than one week, requiring the implantation of a permanent pacemaker (DDD). Complete atrioventricular block induced during left heart catheterization is very rare. Pre-existing RBBB with left anterior or posterior hemiblock and reduced left ventricular function may be common factors in patients with this condition. Emergency pacing equipment should always be on-line when left heart catheterization is conducted in such patients.
一名75岁男性因频发室性早搏和左心室功能减退接受了心脏导管检查。入院时心电图显示完全性右束支传导阻滞（RBBB）和左前分支阻滞。右心导管检查顺利进行，但当猪尾导管插入左心室时突然发生了完全性房室传导阻滞（CAVB）。电生理研究将此CAVB确定为希氏束（HV）阻滞，并在窦性心律时显示HV间期延长。冠状动脉造影显示无阻塞性病变或麦角新碱诱发的痉挛。证实了CAVB的可重复性。最终的CAVB发生并持续了一周以上，需要植入永久性起搏器（DDD）。左心导管检查期间诱发的完全性房室传导阻滞非常罕见。存在预先存在的RBBB合并左前或左后分支阻滞以及左心室功能减退可能是此类患者的常见因素。当对此类患者进行左心导管检查时，应急起搏设备应始终处于备用状态。
